Apparatus for Osteotomy and Graft Preparation

ABSTRACT

Surgical tools that increase surgical accuracy for orthopedic procedures involving long bone osteotomy with or without supplementation with allograft or autograft. Two clamps on the operative side are rigidly interconnected to one another with an adjustable rod that is locked into place, preserving length and rotation of the bone. A graft preparation device is used on the operative table. It enables alignment of the graft to preserve the desired mechanical and anatomic axes and to provide rigid fixation of the graft for cutting. Adjustable jigs ensure exact cuts.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of and claims priority to prior filedInternational Application No. PCT/US2010/044247 entitled “APPARATUS FOROSTEOTOMY AND GRAFT PREPARATION,” filed Aug. 3, 2010, which claimspriority to U.S. Provisional Patent Application No. 61/231,112, entitled“APPARATUS FOR OSTEOTOMY AND GRAFT PREPARATION,” filed Aug. 4, 2009, allof which are hereby incorporated by reference into this disclosure.

BACKGROUND OF THE INVENTION

1. Field Of the Invention

This invention relates, generally, to tools used in orthopedic surgery.More particularly, it relates to tools that enable resection of patientbone in the setting of trauma or bone tumors and the accuratepreparation of allograft to fill deficient patient bone afterresections.

2. Brief Description of the Related Art

Allograft (bone harvested from human cadavers) is used commonly inorthopedic tumor surgery and is also used to replace bony deficits inorthopedic trauma surgery. Following resection of small and large piecesof bone for the cure of bone tumors, allograft replacements for theresected bone are fashioned from bulk specimens of treated cadaver bone.In procuring these replacement parts, healing is facilitated by ananatomic (accurate) fit of the allograft replacement. Electricreciprocating saws, which are difficult to guide, are used to cutallograft replacement parts. When used for total knee replacement, thesesaws are used in conjunction with metal jigs that guide the saw bladeand ensure accurate cuts. Such guides, however, are not currentlyavailable for use for shaping allograft to replace bone deficits.

Accordingly, what is needed in the art are specially designed clamps andjigs for use in the operating room to aid both in the accurate resectionof patient bone and the preparation of cadaver bone. However, in view ofthe prior art considered as a whole at the time the present inventionwas made, it was not obvious to those of ordinary skill in the art howthe limitations of the art could be overcome.

However, in view of the art considered as a whole at the time thepresent invention was made, it was not obvious to those of ordinaryskill in the field of this invention how the shortcomings of the priorart could be overcome.

BRIEF SUMMARY OF THE INVENTION

The long-standing but heretofore unfulfilled need for improved tools foruse in orthopedic surgery is now met by a new, useful, and non-obviousinvention.

The inventive structure includes a plurality of tools for use in theoperating room that aid both in the accurate resection of patient boneand the preparation of cadaver bone. The devices include bone clampswith interchangeable jigs that are applied to the patient's bone insurgery and a device used on the “back table” in the operating room thatincludes bone clamps and cutting jigs to prepare a reciprocal piece ofallograft that will interdigitate with the patient's bone.

The clamps are modifications of the conventional Lane bone clamp orself-centering bone forceps and include a handle and forceps forgrasping a bone.

The bone resection device includes a pair of bone clamps each having ahandle end and a clamping end. A pair of receiving slots is disposed onthe clamping ends of each clamp. Both pairs of receiving slots areadapted to receive a cutting jig. Curved struts extend from the topsurface of the clamping end of each clamp. The distal ends of the curvedstruts include receiving holes. A securing rod is disposed between thecurved struts within the receiving holes. The securing rod rigidlyinterconnects the clamps.

The allograft preparation device includes a tabletop having a pluralityof parallel, longitudinally extending grooves formed therein. A firstpair of blocks is slideably disposed in a preselected groove of theplurality of grooves. The first pair of blocks includes circular discspointing to a center of the tabletop. The circular discs includestationary sharpened points at a center of the discs to align ananatomic axis of an allograft piece by pressing the allograft piece intothe sharpened points.

A second pair of movable blocks is secured in a preselected groove ofthe plurality of grooves. The second pair of blocks support adjustablearms that hold bone clamps (similar to the ones described above) thatsecure the allograft piece against movement. Once the allograft piece issecured against movement by the bone clamps, the first pair of blocks isretracted.

A third pair of blocks is slideably disposed in a preselected groove ofthe plurality of grooves and holds cutting jigs that are mounted to acylinder that, prior to being secured against movement by a threadedhandle, is rotated to adjust a preselected angle of cut as needed.

The novel devices significantly improves results with the use ofallograft as tight allograft-to-bone contact is required to encourageadequate healing of patient bone to allograft.

The primary object of this invention is to advance the art of orthopedicsurgery by providing tools that aid a surgeon in performing accurateresection of patient bone and the preparation of cadaver bone.

These and other important objects, advantages, and features of theinvention will become clear as this description proceeds.

The invention accordingly comprises the features of construction,combination of elements, and arrangement of parts that will beexemplified in the description set forth hereinafter and the scope ofthe invention will be indicated in the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

For a fuller understanding of the nature and objects of the invention,reference should be made to the following detailed description, taken inconnection with the accompanying drawings, in which:

FIG. 1A is a side elevational view of a novel clamp having straightarms;

FIG. 1B is a side elevational view of a novel clamp having curved arms;

FIG. 2 is a top plan view of the clamps depicted in FIGS. 1A and 1B,said clamps having a common appearance when depicted in plan;

FIG. 3 is a perspective view of a bone resection device;

FIG. 4A is a top plan view of an articulated-rectangular interconnectingrod;

FIG. 4B is a side elevational view of the structure depicted in FIG. 4A;

FIG. 4C depicts two articulated-rectangular interconnecting rods when inperpendicular relation to one another;

FIG. 5A is a top plan view of a first novel jig;

FIG. 5B is a side elevational view of the jig depicted in FIG. 5A;

FIG. 5C is an end view of the jig depicted in FIGS. 5A and 5B;

FIG. 5D is a top plan view of a second novel jig;

FIG. 5E is a side elevational view of the jig depicted in FIG. 5D;

FIG. 5F is an end view of the jig depicted in FIGS. 5D and 5E;

FIG. 5G is a top plan view of a third novel jig;

FIG. 5H is a side elevational view of the jig depicted in FIG. 5G;

FIG. 5I is an end view of the jig depicted in FIGS. 56 and 5H;

FIG. 6 is a top plan view of a back table allograft cutting device;

FIG. 7 is an end view of the structure depicted in FIG. 6;

FIG. 8A is a top plan view of a first novel back table allograft cuttingjig;

FIG. 8B is a side elevational view of the cutting jig depicted in FIG.8A;

FIG. 8C is an end view of the cutting jig depicted in FIGS. 8A and 8B;

FIG. 8D is a top plan view of a second novel back table allograftcutting jig;

FIG. 8E is a side elevational view of the cutting jig depicted in FIG.8D;

FIG. 8F is an end view of the cutting jig depicted in FIGS. 8D and 8E;

FIG. 8G is a top plan view of a third novel back table allograft cuttingjig;

FIG. 8H is a side elevational view of the cutting jig depicted in FIG.8G; and

FIG. 8I is an end view of the cutting jig depicted in FIGS. 8G and 8H.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The novel system increases surgical accuracy for orthopedic proceduresinvolving long bone osteotomy with or without supplementation withallograft or autograft. Difficulties with long bone osteotomy with orwithout graft placement include obtaining the desired final length,preventing malrotation of the osteotomized ends, ensuring exact fit ofthe united bone ends, and maintaining all of these elements withstability when final fixation is applied. Additional difficulties arisewhen using an interposition graft as the graft must be prepared so asnot to disrupt the long bone's anatomic or mechanical axes. Thisinvention addresses these aspects of long bone osteotomy and graftpreparation.

The novel system has two components. On the operative side, a boneresection device includes two clamps (these may be modeled on a Lanebone clamp or a self-centering bone forceps) that are rigidlyinterconnected to one another with an articulated rectangular rod thatis locked into place, preserving length and rotation of the bone. Thesecond component is a graft preparation device used on the operativetable. This device enables alignment of the graft to preserve thedesired mechanical and anatomic axes. It also secures the graft againstmovement to facilitate cutting of the graft. Adjustable jigs ensureexact cuts.

FIGS. 1A and 1B are diagrammatic representation of clamp 10 havingutility in connection with a bone resection device. The clamps includehandle end 16 and clamping end 18 that are mechanically engaged viahinge 30. Mechanically, clamp 10 functions like a standard clamp, i.e.,as handle end 16 is engaged, clamping end 10 opens and closes. The innerportion of clamping end 18 is notched to accommodate the placement ofplates which are used commonly in orthopedic surgery for fixation. Thesenotches allow the plate(s) to be placed with the clamps in place so thatrotational alignment of the cut bone ends is maintained until the plateis secured to the bone and the allograft with bone screws.

Curved strut 24 extends from the top surface of clamping end 18. Thedistal end of curved strut 24 includes receiving hole 26 and wing nut 28which are adapted to receive and secure a securing rod as discussedhereafter. Curved strut 24 extends outward and away from handle end 16to keep the securing rod out of the operative field of a surgeon.

Handle end 18 may be curved (arcuate) or straight to facilitateinsertion into deep incisions.

As depicted in FIGS. 1A-2, receiving slots 20 are disposed on clampingend 18 and include two transverse slots. The transverse slots includelip 32 for receiving a cutting jig.

As depicted in FIG. 3, bone resection device 40 enables a surgeon topreserve the length and rotation of a bone resection. Bone resectiondevice 40 includes a pair of clamps 10 each having handle end 16,clamping end 18, curved strut 24 (with receiving hole 26 and wing nut28), and receiving slots 20, as previously discussed. A first clamp isplaced just proximal to the resection and a second clamp is placed justdistal to the resection. Both clamps are locked in a closed, clampingposition using a paw and ratchet locking mechanism or a strap to forcethe handle together. Any known means may be used to secure the clamps.

Still referring to FIG. 3, securing rod 42 is disposed between thecurved struts within receiving holes 26 and secured in place via wingnut 28. Accordingly, securing rod 42 rigidly interconnects the clamps.An additional securing rod may be necessary to counteract compressionforces from the soft tissues on the bone ends if necessary, securing rod44 is disposed between handles 18 of clamps 10. An additional wing nut28 may be incorporated to secure securing rod 44. As depicted, thesecuring rods are rectangular metal rods. A rectangular rod preventsrotation between the clamps; however, the rod may be any shape andlength necessary to rigidly interconnect the clamps. The securing rodsmay also include a ruler to record length and assure accuraterepositioning. Moreover, the securing rod may include a universal jointthat is lockable to a desired angle.

FIG. 4A depicts in top plan view the rectangular interconnecting rodthat interconnects the two clamps to one another and preserves a fixedlength and rotation. FIG. 4B is a side elevational view thereof. A rulerhaving metric, centimeter and millimeter demarcations is included fortaking measurements for the portion of bone to be cut on the ‘backtable’ and for restoring a desired length if the rod must be removed forany reason. In an embodiment, the rod has two rotating joints 60 and 62located mid-length forming a locking universal joint. Joints 60 and 62allow rotation of one rod arm with respect to the other in one plane ofmotion. The joints are placed in perpendicular orientation to oneanother to allow three-dimensional motion as indicated in FIG. 7C, thusacting as a universal joint. Each joint has a protractor showingone-hundred and eighty degrees of motion. Angle readings from theseprotractors direct the surgeon to the correct settings of the ‘backtable’ cutting device (discussed hereafter) in order to create anidentical allograft replacement. The joints have lockable pivots asindicated by the transverse lines that enable the rod to be fixedrigidly in the orientation of the bone clamps once the clamps have beenapplied to the bone to be resected.

Cutting jigs are disposed within receiving slots 20. Receiving slots 20are formed to accommodate the smaller dimensions of the cutting jig inFIGS. 5B, 5E, 5H and in FIGS. 5C, 5F, 5I, thereby allowing the largerdimensions in these figures to abut the top of receiving slots 20 toprovide a secure fit and prevent fall-through. The cutting jigs aretherefore oriented so that the slot that permits passage of a saw bladeis perpendicular to the bone. Once the cutting jigs are inserted intoreceiving slots 20, a typical reciprocating bone saw with an appropriatesaw blade can be used to perform the bone cuts.

FIGS. 5A-I depict the types of cutting jigs that accompany the boneclamps shown in FIGS. 1A-3. These cutting jigs enable a surgeon to maketransverse cuts, step cuts, notch cuts, or any other type of cut in thebone to be resected.

All of the aforementioned components are preferably made of surgicalgrade stainless steel; however, other materials may be used.

FIG. 6 depicts a back table allograft cutting device in plan view. Thisdevice is used to cut the allograft to specification for the replacementof the resection. Table top 50 of the cutting device is preferably madeof machined stainless steel.

Tabletop 50 has three longitudinally extending grooves formed therein,collectively denoted as 52. Each groove has an inverted “T”configuration. These grooves receive the sliding/locking invertedT-shaped devices that lock the cutting jigs and allograft stabilizingdevices to tabletop 50. A ruler is engraved in the tabletop in parallelrelation to the grooves.

First pair of stainless steel blocks 54 is slideably mounted in thecenter groove and have circular discs 56 pointing to the center of thetabletop and sharpened points 58 in the center of the discs. This devicealigns the anatomic axis of the allograft piece to be cut by pressingthe allograft into the stationary sharpened points 58, enabling theoperator to anchor the center of the allograft with a pair of boneclamps 60. Blocks 54 may be retracted to opposite ends of the deviceafter bone clamps 60 are placed into their respective operativeconfigurations. This could be necessary depending on how close to theends the cuts must be made.

Second pair of blocks 55 is slideably mounted in the lower groove asdepicted. Blocks 55 support adjustable arms that hold bone clamps 60that anchor the allograft to be cut.

Third pair of stainless steel blocks 56 is slideably mounted in theupper groove as depicted. Blocks 56 hold cutting jigs 57. Multiplecutting jigs are available, depending on whether the surgeon desires atransverse cut (see FIGS. 8A-C), a step cut (FIGS. 8D-F), or a notch cut(FIGS. 804). The cutting jigs are mounted to cylinder 58 which, prior tobeing locked down by a threaded handle, are rotated to adjust the angleof cut, if desired. A pointer at the base of the cylinder indicates theselected angle. A cutting jig 57 is mounted to each movable stainlesssteel block 56. A cutting jig for a transverse cut is depicted butmultiple cutting jigs are available, depending on whether the surgeondesires a transverse cut, a step cut, or a notch cut, as aforesaid. Armshold bone clamps 60 for the clamping of the allograft specimen forcutting. The arms have lockable pivots (see transverse lines) thatenable adjustments in clamp location. The pointer indicates the positionof the cutting jig in reference to the ruler. Wing nuts 11 secure alladjustable components against movement.

FIG. 7 depicts the allograft cutting device in end view.

FIGS. 8A-I depicts the cutting jigs for the back table graft preparationdevice. These enable transverse (FIGS. 8A-C), notch (FIGS. 8D-F), andstep cuts (FIGS. 8G-I) of the graft ends.

It will thus be seen that the objects set forth above, and those madeapparent from the foregoing description, are efficiently attained andsince certain changes may be made in the above construction withoutdeparting from the scope of the invention, it is intended that allmatters contained in the foregoing description or shown in theaccompanying drawings shall be interpreted, as illustrative and not in alimiting sense.

It is also to be understood that the following claims are intended tocover all of the generic and specific features of the invention hereindescribed, and all statements of the scope of the invention that, as amatter of language, might be said to fall therebetween.

1. An apparatus having utility in orthopedic surgery for the resectionof hone, comprising: a first clamp having a handle end and a clampingend; a first pair of receiving slots disposed on said clamping end ofsaid first clamp; a first cutting jig disposed within said first pair ofreceiving slots; a first curved strut having a proximal end attached toa top surface of said clamping end of said first clamp and a distal endopposite said handle end of said first clamp, said distal end of saidfirst curved strut having a receiving hole; a second clamp having ahandle end and a clamping end; a second pair of receiving slots disposedon said clamping end of said second clamp; a second cutting jig disposedwithin said second pair of receiving slots; a second curved strut havinga proximal end attached to a top surface of said clamping end of saidsecond clamp and a distal end opposite said handle end of said secondclamp, said distal end of said second curved strut having a receivinghole; and a first securing rod disposed between said first curved strutand said second curved strut within said receiving holes, wherein saidfirst securing rod interconnects said pair of bone clamps.
 2. Anapparatus having utility in orthopedic surgery for the resection of boneas in claim 1, further comprising: means for adjustably securing saidfirst securing rod to said first curved strut and said second curvedstrut.
 3. An apparatus having utility in orthopedic surgery for theresection of bone as in claim 2, further comprising: said means foradjustably securing said first securing rod to said first curved strutand said second curved strut being a wing nut.
 4. An apparatus havingutility in orthopedic surgery for the resection of bone as in claim 1,further comprising: measuring means disposed on said first securing rod.5. An apparatus having utility in orthopedic surgery for the resectionof bone as in claim 1, further comprising: a second securing rod, saidsecond securing rod being disposed between said pair of handles of saidpair of bone clamps, wherein said second securing rod interconnects saidpair of bone clamps.
 6. An apparatus having utility in orthopedicsurgery for the resection of bone as in claim 5, further comprising:said second securing rod having a universal joint at its longitudinalmidpoint.
 7. An apparatus having utility in orthopedic surgery for theresection of bone as in claim 1, further comprising: said first securingrod having a universal joint at its longitudinal midpoint.
 8. Anapparatus having utility in orthopedic surgery for the resection of boneas in claim 1, further comprising: means for securing said first andsecond clamps around a bone.
 9. An apparatus having utility inorthopedic surgery for graft preparation to prepare a reciprocal pieceof allograft, comprising: a tabletop; a plurality of parallel,longitudinally extending grooves formed in said tabletop; a first pairof blocks slideably disposed in a preselected groove of said pluralityof grooves, said first pair of blocks having circular discs pointing toa center of said tabletop and having stationary sharpened points at acenter of said discs to align an anatomic axis of an allograft piece bypressing said allograft piece into said sharpened points; a second pairof movable blocks secured in a preselected groove of said plurality ofgrooves, said second pair of blocks supporting adjustable arms that holdbone clamps that secure said allograft piece against movement, saidfirst pair of blocks being retracted to a preselected end of saidapparatus after said bone clamps are positioned to secure said allograftpiece; and a third pair of blocks slideably disposed in a preselectedgroove of said plurality of grooves that hold cutting jigs that aremounted to a cylinder that, prior to being secured against movement by athreaded handle, is rotated to adjust a preselected angle of cut asneeded.
 10. An apparatus having utility in orthopedic surgery for graftpreparation to prepare a reciprocal piece of allograft as in claim 9,further comprising: a pointer disposed on said cylinder for indicatingsaid preselected angle.
 11. An apparatus having utility in orthopedicsurgery for graft preparation to prepare a reciprocal piece of allograftas in claim 9, further comprising: a plurality of fastening means fortightening adjustable components of said apparatus.
 12. An apparatushaving utility in orthopedic surgery for graft preparation to prepare areciprocal piece of allograft as in claim 9, further comprising: alongitudinally extending ruler engraved in said tabletop in parallelrelation to said grooves;
 13. An apparatus having utility in orthopedicsurgery for graft preparation to prepare a reciprocal piece of allograftas in claim 9, further comprising: said plurality of parallel,longitudinally extending grooves formed in said tabletop being T-shaped.14. An apparatus having utility in orthopedic surgery for graftpreparation to prepare a reciprocal piece of allograft as in claim 9,further comprising: said first, second, and third pair of blocks eachhaving inverted T-shaped pins slideably disposed in a preselected grooveof said plurality of grooves.